Radiology practices are always looking for real-world approaches that can help solve today’s complex healthcare challenges and deliver better patient care. The ACR spoke with Ben C. Wandtke, MD, MS, associate professor and vice chair of quality and safety in the department of imaging sciences at the University of Rochester (UR) Medical Center, to learn how participating in the ACR Learning Network and attending the 2023 Quality and Safety + Informatics Conference can lead to an action plan for quality improvement.
What is the ACR Learning Network and how does it contribute to quality improvement?
The ACR Learning Network is an initiative to improve diagnostic imaging care through a learning health systems approach. A radiologist expert leads each of four improvement collaboratives that are focused on improving lung cancer screening, mammography positioning, prostate MR image quality and recommendations follow-up (RFU). The collaboratives are comprised of teams from three to six sites per cohort working together to solve the same problem, at the same pace and time, within their respective healthcare settings.
Each collaborative develops and refines one or more performance measures to support the progress of the individual site projects and the progress of the entire collaborative. Learning together helps identify common methods to achieve excellent performance in these four important areas of cancer diagnoses.
The Learning Network focuses on improvement-driven metric design, which is the real-world application of performance metrics that directly impact the outcomes of patients involved in these programs. Instead of a group of experts getting together and determining the right way to measure success, our teams work collaboratively to gather data and measure program success via metrics that have been tested and refined in real-world settings.
What is the status of the first cohort of improvement collaborative participants, and what new opportunities lie ahead as you move into the second and third cohorts?
The first cohort graduated at the end of 2022, and those organizations are now transitioning into the ongoing phase of collaborative participants, where they will continue to share their data with the collaborative. Cohort 1 sites have laid important foundational work, such as defining problems, refining quality improvement measures and developing process maps that will support subsequent cohorts in getting off to an accelerated start. Participants will share measures, common issues and solutions to improve performance, so we continue to get stronger as a learning network as we grow with each cohort. This common support infrastructure will also address multiple problems and sustain the Learning Network over time.
The second cohort is now getting underway, and we are accepting rolling applications for cohort 3, so we invite any sites that are interested in participating in the ACR Learning Network to join us.
As the physician lead for the RFU collaborative, what are your goals for the upcoming cohorts?
The RFU collaborative addresses the problem of incidentally detected lung nodules. Lung nodules are incredibly common, identified in millions of patients each year in the U.S. While only a small minority of lung nodules represent lung cancer, the huge number of lung nodules identified results in an opportunity to identify many more early-stage lung cancers. Despite their prevalence, management of lung nodules is highly variable and many are simply ignored.
The RFU collaborative is attempting to identify the most worrisome lung nodules and standardize follow-up care, essentially creating programs of opportunistic screening. We've worked hard in the first cohort to identify ways to standardize the recommendations being made to assure that all appropriate nodules of significant size have a recommendation for follow-up.
In addition, we worked to measure and improve follow-up compliance with our recommendations. Our goals for the next cohort include identifying metrics for success in incidental nodule tracking that can be readily applied and potentially used for value-based payment programs in the future.
When it comes to lung nodules, why is standardizing recommendations and creating real-world measures for follow-up care so important?
We believe that every patient deserves their best chance for a cure, and early-stage diagnosis is the best way to guarantee that. About half of potentially malignant lung nodules are not followed up currently at most sites around the country, despite radiology recommendations to do so, which places many patients at risk for delayed diagnosis of lung cancer. With five-year survival rates for early-stage lung cancer being relatively high (over 60%), there is a significant benefit to identifying more early-stage lung cancers.1,2
Tracking programs for incidental findings work very well in conjunction with lung cancer screening programs to increase the percentage of lung cancers diagnosed at an early, more treatable stage. In our experience, about three-quarters of lung cancers identified through tracking programs are caught at an early stage, which potentially represents many lives saved.
How does the RFU learning collaborative contribute to real-world solutions?
Tracking incidental lung nodules is a complex problem. Complex problems often require teams and significant iteration on early ideas to solve them. This lends itself well to performance improvement tools that the collaboratives are using.
As part of the process, participants measure the performance of their programs and look in depth at the root causes for failure in their programs when things aren't working well. This leads to the identification of key drivers for success and the development of focused interventions to improve performance. We measure that performance over time, and we share the results transparently with other collaborative participants. When one site identifies a breakthrough, it is shared with all the other collaborative participants, who can attempt to replicate that improvement effort and determine if it works in their environment as well. That’s the power of collaborative learning.
What are you most excited about for the future of the RFU collaborative?
We are still at the cutting edge of quality improvement in recommendations follow-up. Right now, only a minority of organizations are actively participating with incidental findings tracking programs, so there is not a great deal of literature on the topic or a clear best practice for how often and what message to communicate to patients and providers. We simply don't know the best way to tackle this problem yet. We believe the fastest way to identify best practices is to have multiple organizations attempting to tackle this problem with many different approaches and sharing their successes and failures openly. The Learning Network approach should help the radiology community reach a best practice state much faster than is possible with individual organizations working in a vacuum.
Why should people attend the 2023 Quality and Safety + Informatics Conference?
There are a few big changes happening in 2023. The first is that the conference will be moving to the West Coast for the first time in several years. It will be held Oct. 24–26 at the Sheraton San Diego Hotel in California. The meeting is scheduled midweek, to allow for travel time while avoiding conflicts with family obligations and weekend call duties.
The planning committee has made a conscientious effort to broaden the scope of content to ensure the meeting is relevant not just to experts in quality and safety, but to anyone with a leadership role in clinical operations or informatics. Whether you are a radiologist or a staff leader, we'll have content for everyone.
We are also working with the ACR Informatics Summit planning committee to more closely integrate the two meetings with a full day of overlapped content as part of a three-day conference. The overlap among operations, informatics and quality improvement — especially in areas like lung cancer screening, incidental findings and AI — creates synergies and significant opportunities to enhance patient care.
If you could pick just one conference to attend to learn from the leaders in quality and safety, this is it. There's just no other conference that provides this level of focused attention on quality and safety.